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03101
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- �l
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OWNER'S NAME - -- u-
ca e a.
S , e`� IA ft)
PHONE
SITE LOCATION !Is
S �N Ct
a tiv ee_ iY
��
l L'�rN L�1^c. V G T M#
MAILING ADDRESS A .
0, 95A.
D A, L1 e V GU • � f O S % `I
PERSON INTERVIEWED
PCHD Complaint #
Name
& Relationship (i.e,
owner,tenant,'etc.)
DATE
TYPE FACILITY
PROPOSED INSTALLER
o
�. o Es r G!�A e
PHONE q 1 'q- Sag -a ar 9 S
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal fran licensed professional engineer or
registered architect.
OA J ✓/�/Ly✓ �o.r4 a
Proposal approved
Inspector's Signature,0VTitle
Proposal Disapproved
Proposal awroved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:.
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
/Date
(e.,g.,house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or reported agent of owner agree to the above conditions.
SIGNATURE TITLE O ua BV a DATE 9�
IIIES: *Ite (IXID); Yells (Tam ED; Pink (ARIiamt)
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
�"�'�""'�vR�Ta"r'►1 �oCJL�1V"A�1,•kld, PVI51V � .. "..` -v - .- T
Associate Commissioner of Health
Gunther
43 Shawnee Road
Putnam Valley, NY 10579
Dear Ms. Gunther:
ROBERT J. BONDI
County Executive
e-ea� ct .'a.�ee:�x::a:.a,.�.�.:• ..�. ^ �j •y, •` �•r .wi•^iY =�n
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
April 11, 2005
Re: Addition- Gunther, 43 Shawnee Rd.
No Increases in Number of Bedrooms
(T)Putnam Valley, TM #62.17 -1 -9
I have received and reviewed the plans for the proposed addition to the above - mentioned residence.
The proposal for the addition has been approved as per plans bearing the approval stamp from this
Department dated April 11, 2005. The addition is approved with the following conditions:
The total number of bedrooms must remain at three without prior approval by this
department.
lne'afea f`fhe existing sewage disposal system, and its expansion area, must be
maintained.
3. All plumbing fixtures must be updated with water saving devices, i.e., new low
flush toilets, restrictors for shower heads and faucets, etc.
Any other permits or variances required are the responsibility of the applicant and the jurisdiction of
the Town of Putnam Valley.
If you have any questions, please contact me at your convenience..
ry truly yours
6" � /Z
Joseph Paravati
JP: hn Assistant Public Health Engineer
cc:BI (T)Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
.BRUCE R. FOLEY
Public - Health Dire . _ . -T —• -
crr•� a:�.;yi. �.:.p�ac- a•.vaa•: ,L. ;w�T:•- e.R.'+�_
DEPARTMENT OF - HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 6130 Fax (845) 278 - 7921 d
Nursing Services (845) 278 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
' ADDITION APPLICATION (RESIDENTIAL ONLY)
/
STREET '7` 3 TOWN X MAP#
NATN - J PJ J 0WVthVPHONEVa�o�c;03 PCHD#
MAILING ADDRESS ?� 694(AJAm,-- 4 - �vnquw " vo5
DESCRIPTION OF ADDITION
\
'LUMBER OF EXISTING BEDROOMS, PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR) AT'Tt4C0D
*Any addition which is considered a bedroom requires formal approval of plans (Construction Permit)
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code.
he f„1, i g 1 -u-u •am- - :,csafft aitn ep ; Geneva Road,�rewster, NY
10509, Phone 278 -6130.
I/1. Certified check or money order for $100.00. .
I/' 2. Sketches of existing.floor plan (drawn to scale, all living area including basement)
'*Non-professional sketches are acceptable.
/3. Two sets of proposed floor plan (drawn to scale, with name, street; and tax map #)
*Non - professional sketches are acceptable.
✓4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of
installation if known. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
V15. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
Whouseguidelines
.- r
BRUCE R. FOLEY
Public Health Director
_.. .-,- -r - - - - ,- aS�J,.;. v.. !_.w•K ."a 'ems �••.w
DEPARTMENT' OF
I Geneva Road
Brewster, New York
10509
LORETTA .- MOLINARi�R.Ai.
ra�C-Puoi ' Healthy Director
Director of Patient Services
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Prescbool (845) 278-6082 Fax (845) 278 - 6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
.0/#0' �
Re: &Air- P5fl-�,
Residence
Tax Map
Town tic,
According to records maintained by .the Town, the above noted dwelling
IS
ZOO
_ IS NOT
in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER
BFhouse
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reputed location
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reputed location Poscibla future
of leaching pit 10PUtod location
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Plan based on survey by A. BUNNEYI L.S.
Lot 97 "Modified Map No. 2 Of Abele Park" FM 6B
Application subject to 'Local Law 1, 1978
No SSDS within 100' of proposed well . except as qhn.r,
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". SURVEYED & PREPARED BY
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"All ce- tifications hereon are valid' for the map end copies 5 , tl
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